Houmannkjeldgaard1816

58; 95% CI, 1.15 to 2.18; P=.005). Further propensity score matching attenuated the association but still showed that patients using PPIs had a higher rate of GI bleeding (0.8% vs 0.6%; P=.04).

In China, PPIs are widely used within 24 hours of admission in patients with ACS taking DAPT. An increased risk of GI bleeding is observed in inpatients with early PPI use. Randomized trials on early use of PPIs in patients with ACS receiving DAPT are warranted.

clinicaltrials.gov Identifier NCT02306616.

clinicaltrials.gov Identifier NCT02306616.Central nervous system (CNS) involvement by haematological malignancies is uncommon, and generally associated with a poor prognosis. Neuroimaging plays a key role in the accurate diagnosis, including in the critical differentiation from other processes such as infection and treatment-related toxicity. This review illustrates a variety of manifestations of CNS involvement by haematological malignancies and relevant differential diagnoses. CNS involvement can be seen in lymphoma (both primary and secondary), Waldenström macroglobulinaemia, multiple myeloma, leukaemia, and the malignant histiocytoses. The typical patterns vary between the different disorders, for example, in the most common sites of involvement and the relative frequency of parenchymal and meningeal involvement. Adjacent structures may also be involved. Nevertheless, there is some overlap in the imaging appearances, with common features including pre-contrast hyperdensity on computed tomography (CT), diffusion restriction, and avid post-contrast enhancement. In the post-treatment context, it is also important to distinguish between disease relapse and post-treatment effects. This includes opportunistic infections and the effects of chemotherapy and/or radiotherapy, including toxic effects and radiotherapy-induced neoplasms.

To evaluate the risk stratification of hepatocellular carcinoma (HCC) and overall malignancies in different contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) categories, and to explore the diagnostic performance of LR-5 for HCC and LR-M for non-HCC malignancies.

The PubMed, Embase, and Cochrane Central databases were searched from 2016 to February 2021 for studies on CEUS LI-RADS v2016 and v2017. The proportion of HCC and overall malignancy in each LI-RADS category and the sensitivity, specificity, accuracy, diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUC) of LR-5 and LR-M categories were determined using a random effects model.

A total of 113 studies were retrieved and 10 studies were included. A total of 5,543 patients with 6,124 lesions were included, including 4,492 HCC. There was no HCC in LR-1, and the proportion of HCC in LR-2-5 increased with the increase of category. The proportion of HCC in LR-5 was 97%, and that in LR-M was 44%. The sensitivity, specificity, and accuracy of CEUS LR-5 for HCC were 0.76, 0.95, and 0.82, respectively, and the area under the SROC curve was 0.83. The sensitivity, specificity, and accuracy of CEUS LR-M for non-HCC malignancies were 0.81, 0.92, and 0.91, and the area under the SROC curve was 0.89.

The risk of HCC increases gradually from LR-1 to LR-5, in which there was no HCC lesion in LR-1 and the proportion of HCC in LR-3 was 22%, lower than that reported in earlier studies. The proportion of HCC in LR-5 was 97% and that in LR-M was 44%. LR-5 has a high specificity of 95% for the diagnosis of HCC.

The risk of HCC increases gradually from LR-1 to LR-5, in which there was no HCC lesion in LR-1 and the proportion of HCC in LR-3 was 22%, lower than that reported in earlier studies. The proportion of HCC in LR-5 was 97% and that in LR-M was 44%. LR-5 has a high specificity of 95% for the diagnosis of HCC.

To evaluate the value and limitations of computed tomography (CT) diagnosis of rib fractures, and to discuss the characteristics of missed rib fractures.

One hundred and sixty chest trauma patients who underwent both early CT (within 48 h) and follow-up CT (14 days later) were enrolled. For early CT examinations, the diagnosis of rib fractures was divided into routine assessment and verification assessment. The detection rates of rib fractures in both patterns were calculated, and the characteristics of missed rib fractures were analysed, based on the imaging results of the twice CT examinations as the reference standard.

A total of 584 fracture sites were confirmed. The overall detection rate of rib fractures in the routine assessment method was 72.4%. In the verification assessment, the detection rates of rib fractures of four observation strategies (axial images, multiplanar reconstruction [MPR], axial images+volume reconstruction [VR] and MPR+VR) were 76.2%, 79.1%, 78.6%, 80.8%, respectively. The incidence of occult fractures was 19.2% (112/584). In both assessment methods, the detection rates of rib fractures at the costochondral junction were the lowest (60%, 65%, respectively); the detection rates ranged from 63.6% to 74.7% for non-displaced rib fractures, but 100% for displaced rib fractures. Most (78.9%) missed rib fractures were accompanied by visible fractures on the same or adjacent first to second rib.

Most missed rib fractures are occult on early CT, which is attributable to the limitations of the CT technique. The number of displaced rib fractures on early CT is a more stable and reliable clinical indicator.

Most missed rib fractures are occult on early CT, which is attributable to the limitations of the CT technique. The number of displaced rib fractures on early CT is a more stable and reliable clinical indicator.Cinematic rendering (CR) is a novel post-processing technique similar to volume rendering (VR), which allows for a more photorealistic imaging reconstruction by using a complex light modelling algorithm, incorporating information from multiple light paths and predicted photon scattering patterns. Several recent publications relating to adult imaging have argued that CR gives a better "realism" and "expressiveness" experience over VR techniques. CR has also been shown to improve visualisation of musculoskeletal and vascular anatomy compared with conventional CT viewing, and may help non-radiologists to understand complex patient anatomy. In this review, we provide an overview of how CR could be used in paediatric musculoskeletal imaging, particularly in complex diagnoses, surgical planning, and patient consent processes. We present a direct comparison of VR and CR reconstructions across a range of congenital and acquired musculoskeletal pathologies, highlighting potential advantages and areas for further research.

To analyse the computed tomography (CT) and magnetic resonance imaging (MRI) features of malignant thymic germ cell tumours (GCTs), in order to improve the accuracy of diagnosis of these tumours.

Twenty-two patients (20 men, two women; age, 28±8.64 years) with malignant thymic GCTs confirmed at histopathology were enrolled retrospectively, and their CT and MRI findings were analysed.

According to the CT findings, malignant thymic GCTs usually manifest as a bulky mass that typically grows to both sides of the midline (20/22, 90.9%), with irregular shape (15/22, 68.2%), lobulation (12/22, 50%), ill-defined margin (9/22, 40.9%), and incomplete capsule (21/22, 95.5%). Twenty masses revealed heterogeneous density with multifocal necrosis or cystic change in 19 (86.4%). Most cases (16/18, 88.9%) showed mild to moderate enhancement, and the branch-like vessel was found in 14 (14/18, 77.8%) cases. The minimum apparent diffusion coefficient (ADC

) and mean apparent diffusion coefficient (ADC

) values in 14 patients were (1.13±0.45) and (1.37±0.49)×10

mm

/s, respectively. Compared with CT findings, the incidences of an incomplete capsule, heterogeneous signal, and necrotic or cystic change on MRI images occurred in all patients with malignant thymic GCT. In addition, peritumoural oedema was found in all 14 (100%) cases.

MRI is superior to CT in showing incomplete capsule, peritumoural oedema, heterogeneous signal, and necrotic or cystic change of GCTs. Branch-like enhancement and multifocal necrosis may help the diagnosis of malignant thymic GCTs.

MRI is superior to CT in showing incomplete capsule, peritumoural oedema, heterogeneous signal, and necrotic or cystic change of GCTs. Branch-like enhancement and multifocal necrosis may help the diagnosis of malignant thymic GCTs.The management of prematurity has evolved considerably since the 1980s thanks to the emergence of developmental care in the United States. In French-speaking Europe, it was not until the 2000s that this was developed. Two programmes are now mainly used in Europe the neonatal individualized developmental care and assessment program and the Bullinger method. They make it possible to establish a partnership between parents and carers, which is essential in the care of these little ones born too early.Early childhood caries is an infectious disease of bacterial origin. It is mainly associated with social inequalities in oral health and affects children from the least privileged backgrounds. Because of its recurrent nature, it is the most common chronic disease in preschool children. Since it shares common risk factors with a number of other chronic conditions (diabetes, obesity), promoting global oral health is essential to achieving a favorable general health status.Bibiane Ramerstorfer is an educator for the judicial protection of youth. She takes care of minors under justice, in civil or penal matters. After having worked in a home, she now works in an open environment and regularly uses the photolanguage® method which, through visuals, allows young people to express their feelings, to share experiences that are sometimes traumatic and to verbalize physical concerns.The main advantage of a pain team is its multidisciplinary nature. The different perspectives and roles of the members of this team (doctor, nurse and psychologist) make it possible to offer more appropriate support to the patient in pain. This is the case of 13-year-old Élio, whose journey and the specificities of pain management have proven to be complex.Christine Baveux is a classics teacher. After having worked in various schools, she joined the team of the Maison de Solenn - Maison des adolescents of the Cochin Hospital as a schooling manager in 2005. Her career, rich in experience, has enabled her to appreciate the suffering that some adolescents may experience at school, a suffering often expressed on the physical level.The Bomoko workshop of the Maison de Solenn-Maison des adolescents of the Cochin hospital is aimed at obese adolescents who are treated at the day hospital during a therapeutic education day. It was born from the common and multidisciplinary desire of a team to propose an innovative device combining psychomotricity and Photolanguage® to encourage the connection between body sensations, emotions and thoughts. SalinosporamideA Thanks to the time of body mediation, the work of expression and psychic elaboration is facilitated during the Photolanguage®.Long-term Covid-19 is now part of our lives and can be questioned by adolescents and their families when faced with long- lasting and unexplained symptoms. This is the case of Alice, a 16-year-old teenager treated at the Cochin Hospital's adolescent centre, who presents digestive disorders and strange body sensations mas-king anxiety-depressive affects.